Health care industry seeing big changes

A health care expert came to town to talk to the Goshen community about the tumult in the system and how it impacts people.

Posted on April 17, 2013 at 1:00 a.m.

GOSHEN — A health-industry expert said the next five years will be tumultuous, since the equivalent of a bunch of elementary-school students have taken the reins in our health system.

Health expert Paul Keckley, Ph.D., talked to community members at Goshen College on Tuesday evening, April 16, at an event put on by IU Health Goshen Hospital and the Goshen Chamber of Commerce.

Talking about “The New Normal in Health Care,” Keckley talked about the sweeping changes in the landscape. “Washington is like 11-year-olds at recess. It's not a pretty picture,” he said.

Health care is going to change dramatically because of federal law, because of the cumbersome way it operates today and because of new technology. “Technology is changing everything we do.”

He said there are things our system does well, but plenty of things need to change. “Why did we have health care reform? The answer is very simple. It's because we can't fix the economy unless we spend less on health care, period,” said Keckley.

He covered a wide range of topics, giving his thoughts and statistics to back them up.

On problems with the system:

Ÿ “We've got an arms race in health care. Everybody wants everyone else's technology ... we've got more PET scans in Florida than in Canada.”

Ÿ “We've got medical specialties that range from three times the median household income ... to 25 times.”

Ÿ Health care costs are 25.5 percent of the federal budget, 21 percent of the average state budget and 19.4 percent of discretionary spending in the average household.

Ÿ Hospitals get seven cents back for every dollar of care they provide to uninsured patients. They get 72 cents per dollar spent on Medicaid patients, and 94 cents per dollar spent on Medicare health care. That leaves everyone else to pay 122 cents per dollar to keep hospitals afloat. “It's a hidden tax,” Keckley said.

What the health care law is intended to do:

Ÿ “A complete replacement of fee-for service ... we get paid to do a lot of stuff.” Instead it aims to go with “fee for results,” even holding hospitals accountable when a patient continues to smoke, even though medical personnel tell him or her to quit.

Ÿ Pull together all health services, “A Sam's Club, Costco model” with common information systems, he said.

Ÿ Attempt to cap spending using a variety of federal advisory boards.

What the future will look like

Ÿ “It's going to be really messy getting from here to there, and there's going to be a lot of unintended consequences with these things. And honestly, we don't know if a lot of them are going to work.”

Ÿ In the budget wrangling going on in Washington, one thing the House, Senate and White House proposals have in common is $500 billion in cuts to Medicare.

Ÿ “There's not enough money for everybody to do what they've always done.”

Ÿ Health care reform doesn't standardize charges for services, he said.

Ÿ It will require providers to track patient satisfaction, efficiency, safety and outcomes.

Ÿ “We've got good docs,” he said, and “most of them don't think many of these things will work.” Still, they're willing to try, he said.

Ÿ In the 1970s there were 7,200 U.S. hospitals. Today it's 5,400. In a decade he expects there to be 4,000 hospitals, and in 25 years, 2,000.

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